Healthcare Provider Details

I. General information

NPI: 1134889413
Provider Name (Legal Business Name): THOMAS KERSCH VIDETICH BYE PT, DPT, MS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S COLLEGE AVE
NEWARK DE
19713-1302
US

IV. Provider business mailing address

142 COUPLES DR
NEWARK DE
19702-2390
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax:
Mailing address:
  • Phone: 952-465-1426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0014482
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: